Platelet ikungahaye kuri plasma (PRP) ikoreshwa cyane muri orthopedie, ariko haracyari impaka zikaze.Kubera iyo mpamvu, Ubudage “Clinical Tissue Regeneration Group Group” yo mu Budage bw’imyororokere n’ihungabana ry’Abadage bakoze ubushakashatsi kugira ngo bumvikane ku bushobozi bwo kuvura PRP iriho ubu.
Porogaramu ya PRP ivura ifatwa nkingirakamaro (89%) kandi irashobora kuba ingenzi mugihe kizaza (90%).Ibimenyetso bikunze kugaragara ni indwara ya tendon (77%), osteoarthritis (OA) (68%), gukomeretsa imitsi (57%), no gukomeretsa kwa karitsiye (51%).Ubwumvikane bwagezweho mu itangazo ryo ku ya 16/31.Gukoresha PRP mu mavi osteoarthritis yo hambere (Kellgren Lawrence II) ifatwa nkigishobora kuba ingirakamaro, kimwe n'indwara zikomeye kandi zidakira.Kubikomere bidakira (karitsiye, imitsi), inshinge nyinshi (2-4) nibyiza kuruta inshinge imwe.Ariko, nta makuru ahagije kumwanya uri hagati yinshinge.Birasabwa cyane guhuza imyiteguro, gusaba, inshuro, no kugena ibimenyetso bya PRP.
Platelet ikungahaye kuri plasma (PRP) ikoreshwa cyane mubuvuzi bushya, cyane cyane mubuvuzi bwimikino ngororamubiri.Ubushakashatsi bwibanze bwa siyansi bwerekanye ko PRP igira ingaruka nziza kuri selile nyinshi ya sisitemu ya musculoskeletal, nka chondrocytes, selile tendon, cyangwa selile imitsi, haba muri vitro ndetse no muri vivo.Nyamara, ubwiza bwibitabo biriho buracyari buke, harimo siyanse yibanze nubushakashatsi bwamavuriro.Kubwibyo, mubushakashatsi bwamavuriro, ingaruka ntabwo ari nziza nkubushakashatsi bwibanze bwa siyansi.
Hariho impamvu nyinshi zishoboka.Ubwa mbere, uburyo bwinshi bwo kwitegura (kurubu sisitemu zirenga 25 zitandukanye ziboneka mubucuruzi) zirahari kugirango tubone platelet zikomoka kumikurire, ariko ibicuruzwa bya PRP byanyuma bigizwe nibihimbano byabo hamwe nimbaraga zabo zikomeye.Kurugero, uburyo butandukanye bwo gutegura PRP bwerekana ingaruka zitandukanye kuri chondrocytes.Byongeye kandi, bitewe n’ibipimo fatizo nkibigize amaraso (selile yamaraso itukura, selile yera, na platine) bitaravugwa muri buri bushakashatsi, hakenewe byihutirwa raporo zisanzwe zibyo bintu.Igicuruzwa cya nyuma PRP nacyo gifite itandukaniro ryihariye kugiti cye.Ikigora ikibazo nuko dosiye, igihe, nubunini bwa progaramu ya PRP bitigeze byuzuzwa, kandi ntibyigeze byigwa neza mubushakashatsi bwibanze bwa siyansi.Ni muri urwo rwego, icyifuzo cyo gukora ibipimo ngenderwaho bya platel biva mu mikurire biragaragara, bizafasha mu gupima ubumenyi bwibanze bwa siyansi yerekana ingaruka ziterwa nibipimo bitandukanye nka formulaire ya PRP, ingano ya PRP, nigihe cyo gutera inshinge.Mubyongeyeho, gukoresha ibyiciro kugirango usobanure neza ibicuruzwa bya PRP byakoreshejwe bigomba kuba itegeko.Bamwe mu banditsi basabye uburyo butandukanye bwo gushyira mu byiciro, harimo nka Mishra (kubara platelet, kuba selile yera, gukora) na Dohan Ellenfest (kubara platelet, kubara amaraso yera, kuba fibrinogen), Delong (P latelet kubara, gukora imisumari, w ^ Haide selile yamaraso; PAW itondekanya) na Mautner (Kubara Platelet, kuba eukocyte nini, kuba R yanditswemo selile yamaraso, no gukoresha imisumari; gushyira mubyiciro bya PLRA)。 Magalon nibindi.Icyiciro cya DEPA cyateganijwe kirimo gutera inshinge OSE, gukora neza, umutekano wa PRP, no kuyikora.Harrison n'abandi.Ubundi buryo bwuzuye bwo gutondekanya ibyiciro byashyizwe ahagaragara, harimo uburyo bwo gukora bwakoreshejwe, ubwinshi bwakoreshejwe, inshuro yubuyobozi hamwe na subcategories zikora, kwibanda kuri platine hamwe nubuhanga bwo gutegura, hamwe numubare rusange ugereranije hamwe numubare rusange (muto wo hejuru) wamaraso yera (neutrophile, lymphocytes, na monocytes) kuri platine, selile zitukura, hamwe na classique.Ibyiciro biheruka guturuka muri Kon n'abandi.Hashingiwe ku bwumvikane bw’impuguke, ibintu byingenzi bisobanurwa nkibigize platine (kwibumbira mu maraso no kugereranya), ubuziranenge (kuba hari uturemangingo tw'amaraso atukura / selile yera), no gukora (endogenous / exogenous, calcium yongeyeho).
Ikoreshwa ry'ibipimo byinshi kuri PRP ryaganiriweho cyane, nko kuba kuvura indwara ya tendon byasobanuwe mu bushakashatsi bw’ubuvuzi bwerekeranye n’ahantu hatandukanye [hamwe n’ibisubizo byiza kandi bibi].Kubwibyo, akenshi ntibishoboka kubona ibimenyetso bifatika mubitabo.Ibi kandi biragoye ko PRP ivura ishyirwa mubuyobozi butandukanye.Kubera ibibazo byinshi bitarakemuka bijyanye no gukoresha PRP, ihame shingiro ryiyi ngingo ni ukugaragaza ibitekerezo by’impuguke zaturutse mu Budage “Clinical Tissue Regeneration Group Group” yo mu Budage bw’imyororokere n’ihungabana (DGOU) ku mikoreshereze n’ejo hazaza. ya PRP.
Uburyo
Itsinda ry’Abadage “Clinical Tissue Regeneration Group Group” rigizwe n’abanyamuryango 95, buri wese azobereye mu kubaga amagufwa no kuvugurura ingirabuzimafatizo (abaganga bose b’ubuvuzi cyangwa abaganga, nta bavuzi b’umubiri cyangwa abahanga mu bya siporo).Itsinda ryakazi rigizwe nabantu 5 (gusubiramo buhumyi) bashinzwe guteza imbere iperereza.Nyuma yo gusuzuma ibitabo bihari, itsinda ryabakozi ryateguye amakuru yamakuru ashobora gushyirwa mubyiciro byambere byiperereza.Ubushakashatsi bwa mbere bwakozwe muri Mata 2018, bukubiyemo ibibazo 13 nibice rusange byerekeranye na porogaramu ya PRP, harimo ibibazo bifunze kandi bifunguye, no gushishikariza abahanga gutanga imishinga cyangwa guhindura.Hashingiwe kuri ibyo bisubizo, icyiciro cya kabiri cy’ubushakashatsi cyakozwe kandi gikozwe mu Gushyingo 2018, hamwe n’ibibazo 31 byose byafunzwe byarangiye mu byiciro 5 bitandukanye: ibimenyetso byerekana imvune ya karitsiye na osteoarthritis (OA), ibimenyetso byerekana indwara ya tendon, ibimenyetso byerekana imvune yimitsi , ikoreshwa rya PRP, hamwe nubushakashatsi buzaza.
Binyuze mu bushakashatsi bwakorewe kuri interineti (Survey Monkey, USA), habaye amasezerano yo kwemerera ababajijwe gusuzuma niba umushinga ugomba gushyirwa mubisabwa byibuze raporo, no gutanga umunzani eshanu zishoboka kuri Likert: 'Emera cyane';Emera;Ntukemere cyangwa ngo urwanye;Ntiwemera cyangwa ntubyemera.Ubushakashatsi bwageragejwe ninzobere eshatu kubijyanye nukuri, kumva no kwemerwa, ibisubizo byahinduwe gato.Mu cyiciro cya mbere, impuguke 65 zose zitabiriye, mu gihe mu cyiciro cya kabiri, impuguke 40 zose zitabiriye.Ku cyiciro cya kabiri cy’ubwumvikane, ubusobanuro bwibanze buvuga ko niba abarenga 75% babajijwe bemeye, umushinga uzashyirwa mu nyandiko yanyuma y’ubwumvikane, kandi abatageze kuri 20% ntibabyemera.75% by'abitabiriye amahugurwa bemeza ko aricyo cyemezo cyumvikanyweho cyane, cyakoreshejwe mu bushakashatsi bwacu.
Igisubizo
Mu cyiciro cya mbere, 89% byabantu basubije ko gusaba PRP ari ingirakamaro, naho 90% byabantu bemeza ko PRP izaba ingenzi mugihe kizaza.Abanyamuryango benshi bamenyereye siyanse yibanze nubushakashatsi bwamavuriro, ariko 58% byabanyamuryango ni bo bakoresha PRP mubikorwa byabo bya buri munsi.Impamvu zikunze kugaragara zo kudakoresha PRP ni ukubura ibidukikije bikwiye, nkibitaro bya kaminuza (41%), bihenze (19%), bitwara igihe (19%), cyangwa ibimenyetso bya siyansi bidahagije (33%).Ibimenyetso bikunze kugaragara mu gukoresha PRP ni indwara ya tendon (77%), OA (68%), gukomeretsa imitsi (57%), no gukomeretsa kwa karitsiye (51%), bikaba aribyo shingiro ryicyiciro cya kabiri cyiperereza.Ibyerekana gukoresha imikoreshereze idahwitse ya PRP igaragara ifatanije na 18% yo gusana karitsiye na 32% yo gusana.Ibindi bimenyetso bigaragara muri 14%.Abantu 9% bonyine ni bo bavuze ko PRP idafite imiti ivura.Gutera PRP rimwe na rimwe bikoreshwa bifatanije na aside hyaluronike (11%).Usibye PRP, abahanga banateye anesthetike yaho (65%), cortisone (72%), aside hyaluronike (84%), na Traumel / Zeel (28%).Byongeye kandi, impuguke zavuze cyane ko hakenewe ubushakashatsi bw’amavuriro ku bijyanye no gukoresha PRP (76%) no gukenera ubuziranenge bwiza (formulaire 70%, ibimenyetso 56%, igihe 53%, inshuro 53%).Kumakuru arambuye kumurongo wambere, nyamuneka reba kumugereka.Impuguke zavuze cyane ko hakenewe ubushakashatsi bwinshi bw’amavuriro ku ikoreshwa rya PRP (76%), kandi hagomba kugerwaho ubuziranenge bwiza (formulaire 70%, ibimenyetso 56%, igihe 53%, inshinge 53%).Kumakuru arambuye kumurongo wambere, nyamuneka reba kumugereka.Impuguke zavuze cyane ko hakenewe ubushakashatsi bwinshi bw’amavuriro ku ikoreshwa rya PRP (76%), kandi hagomba kugerwaho ubuziranenge bwiza (formulaire 70%, ibimenyetso 56%, igihe 53%, inshinge 53%).
Ukurikije ibisubizo, icyiciro cya kabiri cyibanda cyane kumutwe ushimishije cyane.Ubwumvikane bwagezweho mu itangazo ryo ku ya 16/31.Irerekana kandi aho usanga hari ubwumvikane buke, cyane cyane mubyerekanwe.Abantu muri rusange bemeranya (92%) ko hari itandukaniro rikomeye mubimenyetso bitandukanye byerekana PRP (nka OA, indwara ya tendon, gukomeretsa imitsi, nibindi).
Imbonerahamwe yerekana umurongo ugereranya igabanywa ryurwego rwumvikanyweho mugice cya kabiri cyubushakashatsi (ibibazo 31 (Q1 - Q31)), byerekana neza aho batumvikana.
Akabari kuruhande rwibumoso bwa Y-axis yerekana kutumvikana, mugihe umurongo kuruhande rwiburyo werekana amasezerano.Kutavuga rumwe kwinshi bivuka murwego rwo kwerekana.]
Ibyerekana ibikomere bya karitsiye na OA
Hariho amasezerano rusange (77.5%) avuga ko PRP ishobora gukoreshwa mu mavi osteoarthritis kare [Kellgren Lawrence (KL) Urwego rwa II].Kubikomere bidakabije bya karitsiye (KL Urwego rwa I) hamwe nicyiciro gikomeye (KL Urwego rwa III na IV), nta bwumvikane kugeza ubu ku ikoreshwa rya PRP mugihe cyo kubagwa cyangwa nyuma yo kubagwa kwa karitsiye, nubwo 67.5% byabahanga bemeza ko uyu ari umurima utanga icyizere .
Ibimenyetso byerekana ibikomere
Mu bushakashatsi bwakozwe, impuguke zagaragaje umubare munini (82.5% na 80%) ko gukoresha PRP ari ingirakamaro mu ndwara zikaze kandi zidakira.Ku bijyanye no gusana rotate cuff, 50% byinzobere bemeza ko gushyira mu bikorwa PRP bishobora kuba ingirakamaro, ariko 17.5% byinzobere bafite ibitekerezo bitandukanye.Umubare munini winzobere (57.5%) bemeza ko PRP ifite uruhare runini mukuvura nyuma yo kubagwa nyuma yo gusana imitsi.
Kwerekana gukomeretsa imitsi
Ariko nta bwumvikane bwabonetse ku ikoreshwa rya PRP mu kuvura ibikomere bikabije cyangwa bidakira (nko kumvikana hejuru ya 75%).
Ibintu bifatika byo gusaba PRP
Hano hari amagambo atatu ashobora kumvikana:
(1) Ibikomere bidakira bisaba inshinge zirenze imwe ya PRP
(2) Amakuru adahagije kumwanya mwiza uri hagati yinshinge (nta bwumvikane buboneka mugihe cyicyumweru)
(3) Guhinduranya kwa PRP zitandukanye birashobora kugira uruhare runini mubinyabuzima byabo
Ibice by'ubushakashatsi bw'ejo hazaza
Umusaruro wa PRP ugomba kuba mwiza (95% bihoraho) hamwe nubuvuzi bwawo (nkinshuro yinshinge, igihe cyo gusaba, ibimenyetso byubuvuzi).Ndetse no mubice nko kuvura OA aho bivugwa ko hari amakuru meza yubuvuzi, abanyamuryango b’inzobere bemeza ko hakenewe cyane ubushakashatsi bwibanze bwa siyansi n’ubuvuzi.Ibi biranakoreshwa mubindi bimenyetso.
Muganire
Ibisubizo byubushakashatsi byerekana ko hakiri impaka nyinshi ku ikoreshwa rya PRP mu magufwa, ndetse no mu matsinda y’impuguke mu gihugu.Muri disikuru 31, 16 gusa ni zo zumvikanyeho.Hariho ubwumvikane bukomeye mubijyanye nubushakashatsi buzaza, byerekana ko dukeneye gutanga ibimenyetso byagutse binyuze mu gukora ubushakashatsi butandukanye butandukanye.Ni muri urwo rwego, gusuzuma neza ibimenyetso biboneka byakozwe nitsinda ryinzobere ni inzira yo kuzamura ubumenyi bwubuvuzi.
Ibimenyetso bya OA no gukomeretsa kwa karitsiye
Ukurikije ubuvanganzo bwa none, PRP irashobora kuba ikwiranye na OA kare kandi iringaniye.Ibimenyetso biheruka kwerekana byerekana ko inshinge zo mu bwoko bwa PRP zishobora gutera ibimenyetso by’abarwayi hatitawe ku ntera yangirika ya karitsiye, ariko ubusanzwe habaho kubura isesengura ryiza ryitsinda rishingiye ku byiciro bya Kellgren na Lawrence.Ni muri urwo rwego, kubera amakuru adahagije aboneka, abahanga muri iki gihe ntibasaba gukoresha PRP kurwego rwa KL 4. PRP ifite kandi ubushobozi bwo kunoza imikorere ifatanye ivi, bishoboka ko igabanya ingaruka ziterwa no gutwika no kugabanya umuvuduko wo guhindura imikorere ya karitsiye.PRP mubisanzwe igera kubisubizo byiza kubagabo, abato, abarwayi bafite ibyangiritse byo kwangirika kwa karitsiye hamwe nuburinganire bwumubiri (BMI).
Mugihe cyo gusobanura amakuru yubuvuzi yatangajwe, ibigize PRP bisa nkibintu byingenzi.Bitewe n'ingaruka za cytotoxique ya plasma ikungahaye ku maraso yera kuri selile synovial muri vitro, LP-PRP irasabwa cyane cyane gushira imbere.Mu bushakashatsi bwibanze bwa siyansi buherutse gukorwa, ingaruka za selile yera yera (LP) hamwe na selile yera yera (LR) PRP mugukura kwa OA byagereranijwe muburyo bwimbeba nyuma ya meniscectomy.LP-PRP yerekanye imikorere isumba izindi mu kubungabunga ingano ya karitsiye ugereranije na LR-PRP.Isesengura rya meta-isesengura ryibigeragezo byateganijwe ryerekanye ko PRP yagize ibisubizo byiza ugereranije na aside hyaluronic (HA), kandi isesengura ryitsinda ryerekanye ko LP-PRP yagize ibisubizo byiza kuruta LR-PRP.Ariko, nta kugereranya gutaziguye hagati ya LR - na LP-PRP, bituma ubushakashatsi bukenewe.Mubyukuri, ubushakashatsi bunini bugereranya LR-PRP na HA bwerekana ko LR-PRP nta ngaruka mbi.Byongeye kandi, ubushakashatsi bwubuvuzi bugereranya LR-PRP na LP-PRP bwerekanye mu buryo butaziguye ko nta tandukaniro ry’amavuriro mu bisubizo nyuma y'amezi 12.LR-PRP ikubiyemo molekile nyinshi ziterwa no gutwika hamwe n’ibintu byinshi bikura, ariko kandi ikubiyemo ibintu byinshi bya cytokine irwanya inflammatory, nka antleukin-1 ya reseptor antagonist (IL1-Ra).Ubushakashatsi buherutse gukorwa bwasobanuye uburyo bwa “inflammatory regeneration” bwa selile yamaraso isohora porotokore na anti-inflammatory cytokine, byerekana ingaruka nziza kubyuka.Inyigisho zinyongera zubuvuzi hamwe nigishushanyo mbonera cyateganijwe zirakenewe kugirango hamenyekane umusaruro mwiza cyangwa PRP igizwe nuburyo bwiza bwo gusaba muri OA.
Kubwibyo, bamwe bavuga ko HA na PRP bishobora kuba uburyo bwiza bwo kuvura abarwayi bafite OA yoroheje na BMI nkeya.Isuzuma rya sisitemu iheruka kwerekana ko PRP ifite ingaruka nziza zo kuvura ugereranije na HA.Nyamara, ingingo zose zafunguwe zishyizwe hamwe zirimo gukenera gutegura PRP isanzwe, igipimo cyo gusaba, ndetse no gukenera ibizamini by’amavuriro byateganijwe kandi bifite amazi meza.Kubwibyo, kuri ubu ibyifuzo byubuyobozi nubuyobozi ntibisanzwe muburyo bwo gushyigikira cyangwa kurwanya ikoreshwa rya osteoarthritis.Muncamake, ukurikije ibimenyetso biriho, gahunda zitandukanye zo gutegura zigabanya uburyo buhanitse bwo guhinduka, kandi PRP irashobora gutuma ububabare bugabanuka muri OA yoroheje cyangwa yoroheje.Itsinda ryinzobere ntirisaba gukoresha PRP mubihe bikomeye bya OA.Ubushakashatsi buherutse gukorwa bwerekanye ko PRP nayo igira uruhare mu ngaruka za platbo, cyane cyane mu kuvura OA cyangwa Epicondylitis.Gutera PRP birashobora kuba bimwe mubikorwa rusange byo kuvura kugirango bikemure ibibazo byibinyabuzima bya OA.Usibye ibindi bintu byingenzi nko kugabanya ibiro, gukosora dislokisiyo, imyitozo yimitsi, hamwe n ivi, birashobora gufasha kugabanya ububabare no kuzana ibisubizo byiza kubarwayi.
Uruhare rwa PRP mukubaga karitsiye yo kubaga ni akandi gace kagibwaho impaka.Nubwo ubushakashatsi bwibanze bwa siyansi bwerekanye ingaruka nziza kuri chondrocytes, ibimenyetso byamavuriro byerekana ikoreshwa rya PRP mugihe cyo kubagwa, kubagwa kwa karitsiye, cyangwa ibyiciro byo gusubiza mu buzima busanzwe ntibihagije, byerekana ibyo twabonye.Mubyongeyeho, igihe cyiza cyo kuvura PRP nyuma yubuvuzi kiracyamenyekana.Ariko abahanga benshi bemeza ko PRP ishobora gufasha guteza imbere ibinyabuzima bya karitsiye.Muri make, ibisubizo biriho byurubanza rukomeye byerekana ko hakenewe isuzumabumenyi ryerekana uruhare rwa PRP mu kubaga karitsiye.
Ibimenyetso byerekana ibikomere
Gukoresha PRP mukuvura tendinose ni ingingo itavugwaho rumwe mubitabo.Isubiramo ryubushakashatsi bwibanze bwa siyansi ryerekana ko PRP igira ingaruka nziza muri vitro (nko kongera ikwirakwizwa rya selile ya tendon, guteza imbere ingaruka za anabolike, nko kongera umusaruro wa kolagen) no muri vivo (kongera gukira kwa tendon).Mubikorwa byubuvuzi, ubushakashatsi bwinshi bwerekanye ko kuvura PRP bifite ibyiza kandi nta ngaruka bigira ku ndwara zitandukanye zikabije kandi zidakira.Kurugero, isubiramo riheruka ryibanze ku bisubizo bitavugwaho rumwe na porogaramu ya PRP mu gukomeretsa kwa tendon zitandukanye, cyane cyane bigira ingaruka nziza ku nkokora zo mu nkokora zanduye ndetse no gukomeretsa kwa patellar, ariko ntabwo ari kuri Achilles tendon cyangwa rotate cuff lesions.Umubare munini winyandiko zo kubaga RCT zidafite ingaruka zingirakamaro, kandi haracyari ibimenyetso simusiga byerekana ko ikoreshwa muburyo bwindwara ya rotate cuff.Kuri Epicondylitis yo hanze, meta-isesengura yerekana ko corticosteroide igira ingaruka nziza mugihe gito, ariko ingaruka ndende ya PRP irarenze.Ukurikije ibimenyetso biriho, patellar na inkokora yinkokora tendinose yerekanye ko imaze gutera imbere nyuma yo kuvurwa PRP, mugihe Achilles tendon na rotator cuff bisa nkaho bitungukirwa no gusaba PRP.Kubera iyo mpamvu, ubwumvikane buherutse gukorwa na komite y’ubumenyi y’ibanze ya ESSKA bwanzuye ko kuri ubu nta bwumvikane ku ikoreshwa rya PRP mu kuvura tendinose.Nubwo hari impaka mu bitabo, nkuko bigaragazwa n'ubushakashatsi buherutse gukorwa ndetse n'isuzuma rifatika, PRP igira uruhare runini mu kuvura indwara zifata imitekerereze ya siyansi n'ubuvuzi.Cyane cyane urebye ingaruka zishobora guterwa na corticosteroide mugihe ukoresheje indwara zifata.Ibyavuye muri ubu bushakashatsi byerekana ko ubu Ubudage bubona ko PRP ishobora gukoreshwa mu kuvura indwara zikomeye kandi zidakira.
Kwerekana gukomeretsa imitsi
Impaka nyinshi ni ugukoresha PRP mu kuvura ibikomere by'imitsi, iyi ikaba ari imwe mu mvune zikunze kugaragara muri siporo yabigize umwuga, bigatuma hafi 30% by'iminsi y'ikiruhuko.PRP itanga amahirwe yo kuzamura imiti ikiza no kwihutisha igipimo cyimyitozo ngororamubiri, cyitabiriwe cyane mumyaka mike ishize.Nubwo 57% byibisubizo byatanzwe mugice cya mbere cyerekanaga imvune yimitsi nkibimenyetso bikunze gukoreshwa muri PRP, haracyari ikibazo cyubumenyi bukomeye.Benshi mubushakashatsi bwa vitro bagaragaje inyungu zishobora kuba PRP mugukomeretsa imitsi.Kwihutisha ibikorwa bya selile ya satelite, kwiyongera kwa diameter ya fibril yongeye kuvuka, gutera myogenezi, no kongera ibikorwa bya MyoD na myostatine byose byageragejwe neza.Andi makuru yerekeye Mazoka n'abandi.Ubwiyongere bwibintu byibintu bikura nka HGF, FGF, na EGF byagaragaye muri PRP-LP.Tsai n'abandi.yashimangiye ibyavuye mu bushakashatsi.Usibye kwerekana ko poroteyine yiyongereye ya cyclin A2, cyclin B1, cdk2 na PCNA, hagaragajwe ko imbaraga z'imitsi ya skeletale ingirabuzimafatizo no kwiyongera kwa selile byiyongera mu kwimura ingirabuzimafatizo kuva mu cyiciro cya G1 kugeza kuri S1 na G2 & M.Isuzuma riherutse gukorwa ryerekanye muri make ubumenyi bwa siyansi bugezweho ku buryo bukurikira: (1) Mu bushakashatsi bwinshi, kuvura PRP byongereye ubwiyongere bw'ingirangingo z'imitsi, imvugo yo gukura (nka PDGF-A / B na VEGF), kwinjiza amaraso yera, hamwe na angiogenezi mu mitsi ugereranije na moderi yo kugenzura itsinda;(2) Tekinoroji yo gutegura PRP iracyahuye nubushakashatsi bwubuvanganzo bwibanze;. itsinda ryo kuvura.
Nubwo ubushakashatsi bwisubireho bwasobanuye gukira kwuzuye kandi butekereza ko igihe cyo hanze kitari gifite inyungu zikomeye, Bubnov nabandi.Mu bushakashatsi bwakozwe ku bakinnyi 30, byagaragaye ko ububabare bwagabanutse kandi umuvuduko wo gukira amarushanwa wihuta cyane.Hamid n'abandi.Mu igeragezwa ryateganijwe (RCT) ugereranije no kwinjira kwa PRP hamwe nuburyo bwo kuvura indwara zidakira, byasobanuwe ko gukira byihuse mu marushanwa byasobanuwe.Gusa impumyi ebyiri zihumye RCT zirimo imvune ya hamstring mu bakinnyi (n = 80), kandi nta gucengera gukomeye kwagaragaye ugereranije na PRP.Amahame y’ibinyabuzima yizewe, ibyagaragaye neza, hamwe nuburambe bwo kwa muganga hakiri kare hamwe no gutera inshinge PRP twavuze haruguru ntabwo byemejwe na RCT yo mu rwego rwo hejuru.Ubwumvikane buriho mu banyamuryango ba GOTS bwasuzumye imiti igabanya ubukana y’imitsi maze isoza ivuga ko kuri ubu nta kimenyetso cyerekana ko inshinge zishobora gukoreshwa mu kuvura ibikomere.Ibi bihuye nibisubizo byacu, kandi nta bwumvikane buke bwo gukoresha PRP mukuvura imvune.Ubundi bushakashatsi burakenewe byihutirwa kumupanga, igihe, ninshuro za PRP mugukomeretsa imitsi.Ugereranije no gukomeretsa kwa karitsiye, mu gukomeretsa imitsi, gukoresha algorithm yo kuvura, cyane cyane PRP, birashobora kuba bifitanye isano nurwego nigihe cyigihe cyimvune, gutandukanya uruhare rwimitsi ya diameter yakomeretse nibishobora gukomeretsa imitsi cyangwa gukomeretsa avulion.
Umwanya wo gusaba wa PRP ni kamwe mu turere dukunze kuganirwaho, kandi kutagira ubuziranenge ni kimwe mu bibazo by'ingenzi mu bigeragezo bivura.Impuguke nyinshi ntizigeze ziyongera mu ikoreshwa rya PRP, nyamara, ubushakashatsi bumwe bwerekanye ko gukoresha aside aside ya hyaluronike bishobora kugereranywa no gukoresha PRP imwe kuri OA.Icyumvikanyweho ni uko inshinge nyinshi zigomba gutangwa ku ndwara zidakira, kandi umurima wa OA ushyigikiye iki gitekerezo, aho inshinge nyinshi zifite akamaro kuruta inshinge imwe.Ubushakashatsi bwibanze bwa siyansi burimo gukora ubushakashatsi ku mibanire ya PRP, ariko ibisubizo biracyakenewe koherezwa mubushakashatsi bwamavuriro.Icyerekezo cyiza cya PRP ntikiramenyekana, kandi ubushakashatsi bwerekanye ko kwibanda cyane bishobora kugira ingaruka mbi.Mu buryo nk'ubwo, ingaruka z'uturemangingo tw'amaraso yera biterwa no kwerekana, kandi ibimenyetso bimwe bisaba PRP hamwe na selile yera yera.Guhinduka kwa PRP kugiti cye bigira uruhare runini mu ngaruka za PRP.
Ibice by'ubushakashatsi bw'ejo hazaza
Byemeranijweho ko ukurikije ibitabo biherutse, hakenewe ubushakashatsi bwinshi kuri PRP mu gihe kiri imbere.Kimwe mubibazo nyamukuru nuko PRP itegura igomba kuba nziza kurushaho (hamwe 95% bihamye).Ikintu kimwe gishoboka cyo kugera kuriyi ntego gishobora kuba uguteranya platine kugirango ugere ku bunini bunini, burasanzwe.Mubyongeyeho, ibipimo bitandukanye byo gukoresha amavuriro ntibizwi, nkinshuro zingahe zigomba gukoreshwa, igihe kiri hagati yinshinge, na dosiye ya PRP.Gusa murubu buryo birashoboka gukora ubushakashatsi bwo murwego rwohejuru no gusuzuma ibimenyetso bikwiranye no gukoresha PRP, gukora ubushakashatsi bwibanze bwa siyansi nubuvuzi, byaba byiza ubushakashatsi bwateganijwe, bikenewe.Nubwo byumvikanyweho ko PRP ishobora kugira uruhare runini mugihe kizaza, birasa nkaho hakenewe ubushakashatsi bwikigereranyo nubuvuzi.
Umupaka
Imwe mu mbogamizi zishobora kugerwaho n’ubushakashatsi bugerageza gukemura ikibazo cyaganiriweho cyane muri porogaramu ya PRP ni ubwoko bwayo.Kuboneka kwa PRP nibitandukaniro byigihugu mugusubizwa bishobora kugira ingaruka kubisubizo no muburyo bwo kugenzura.Byongeye kandi, ubwumvikane ntabwo butandukanye kandi burimo ibitekerezo byabaganga bamaganga.Ariko, ibi birashobora kandi kubonwa nkibyiza kuko ariryo tsinda ryonyine rishyira mubikorwa no kugenzura imiti yo gutera inshinge PRP.Byongeye kandi, ubushakashatsi bwakozwe bufite ireme ryuburyo butandukanye ugereranije na Delphi yakozwe neza.Akarusho ni ubwumvikane bwakozwe nitsinda ryabaganga babigize umwuga bafite ubumenyi bwumwuga mubyiciro byabo uhereye kubumenyi bwibanze nubuvuzi.
Icyifuzo
Ukurikije ibyumvikanyweho byibuze 75% byinzobere zitabira, gera ku bwumvikane ku ngingo zikurikira:
Imvune ya OA na karitsiye: Gukoresha ivi ryoroheje osteoarthritis (icyiciro cya KL II) birashobora kuba ingirakamaro
Indwara ya Tendon: Gukoresha indwara zikomeye kandi zidakira zishobora kuba ingirakamaro
Icyifuzo gifatika: Kubikomere bidakira (karitsiye, imitsi), inshinge nyinshi (2-4) mugihe gito ni byiza kuruta inshinge imwe.
Ariko, hari amakuru adahagije kumwanya uri hagati yinshinge imwe.
Ubushakashatsi bw'ejo hazaza: Birasabwa cyane guhuza umusaruro, gutegura, gushyira mu bikorwa, inshuro, no kwerekana urugero rwa PRP.Ubundi bushakashatsi bwibanze nubuvuzi burakenewe.
Umwanzuro
Ubwumvikane rusange ni uko hari itandukaniro mubimenyetso bitandukanye byerekana porogaramu ya PRP, kandi haracyari ugushidikanya gukomeye muguhuza gahunda ya PRP ubwayo, cyane cyane kubimenyetso bitandukanye.Gukoresha PRP mu mavi yo hambere osteoarthritis (KL icyiciro cya II) n'indwara zikomeye kandi zidakira zishobora kuba ingirakamaro.Kubikomere bidakira (karitsiye na tendon), inshinge nyinshi intera (2-4) nibyiza kuruta inshinge imwe, ariko hariho amakuru adahagije kumwanya uri hagati yinshinge imwe.Ikibazo gikomeye ni uguhindura ibice bya PRP kugiti cye, bigira uruhare runini mubikorwa bya PRP.Kubwibyo, umusaruro wa PRP ugomba kuba mwiza kurushaho, kimwe nibipimo byubuvuzi nkinshuro zatewe inshinge, nigihe cyo gutera inshinge nibimenyetso nyabyo.Ndetse kuri OA, kuri ubu ihagarariye urwego rwubushakashatsi bwiza bwo gukoresha PRP, ubushakashatsi bwibanze bwa siyansi n’ubuvuzi burakenewe, kimwe nibindi bimenyetso byatanzwe.
Ibiri muri iyi ngingo byongeye gusubirwamo, kandi ntidutanga ingwate iyo ari yo yose cyangwa yerekana ko ari ukuri, kwiringirwa cyangwa kuzuza ibikubiye muri iyi ngingo, kandi ntabwo dushinzwe ibitekerezo by'iyi ngingo, nyamuneka ubyumve.）
Igihe cyo kohereza: Gicurasi-24-2023